Martin Marie, Blaisdell-Gross Bonnie, Fortin Elizabeth W, Maruish Mark E, Manocchia Michael, Sun Xiaowu, Walker David R, Apple Joanna L, Ware John E
Thomson Medstat, Cambridge, MA, USA.
Dis Manag. 2007 Jun;10(3):164-78. doi: 10.1089/dis.2007.103612.
The objective of the study was to examine the burden of coronary artery disease (CAD) and heart failure (HF) on health-related quality of life (HRQOL) and the HRQOL trajectory among participants in a disease management (DM) program characterized by personalized models of education, counseling, and supportive contact. In all, 2,590 CAD and 3,182 HF patients were assessed at baseline and at 3, 6, 9, and 12 months post-enrollment. HRQOL was measured via a computerized dynamic test, whose core consisted of SF-8 items. HRQOL burden was assessed by comparing physical component summary (PCS) and mental component summary (MCS) scores to demographically adjusted US norms and to historical controls. Disease trajectories were assessed with change score analyses and by a categorization of participants as improving, stable, or deteriorating. Among the results, both groups showed between 1.7 to 2.6 times the likelihood of improving over worsening after a full year of DM participation in all measures. In contrast, historical controls experienced no significant HRQOL improvement or decline after 2 years of standard treatment. After 1 or 2 years they were more likely to decline than to improve in their PCS scores and were about as likely to improve as to worsen in their MCS scores. In conclusion, HF places a substantial burden on HRQOL, and the burden of CAD is also noticeable. While the study design does not allow causal interpretations, HRQOL significantly improved for both CAD and HF patients during DM program participation. This trend is in contrast to historic controls, where no significant HRQOL improvement occurred over time.
本研究的目的是，在一个以个性化教育、咨询和支持性接触模式为特征的疾病管理（DM）项目中，考察冠状动脉疾病（CAD）和心力衰竭（HF）对健康相关生活质量（HRQOL）的负担以及参与者的HRQOL轨迹。总共对2590名CAD患者和3182名HF患者在基线以及入组后3、6、9和12个月进行了评估。HRQOL通过一项计算机化动态测试进行测量，其核心由SF - 8项目组成。通过将身体成分总结（PCS）和心理成分总结（MCS）得分与按人口统计学调整的美国标准以及历史对照进行比较，来评估HRQOL负担。通过变化得分分析以及将参与者分类为改善、稳定或恶化来评估疾病轨迹。结果显示，在参与DM满一年后，两组在所有测量指标上改善的可能性均是恶化可能性的1.7至2.6倍。相比之下，历史对照在接受2年标准治疗后，HRQOL没有显著改善或下降。1年或2年后，他们的PCS得分下降的可能性大于改善的可能性，而MCS得分改善和恶化的可能性大致相同。总之，HF给HRQOL带来了沉重负担，CAD的负担也较为明显。虽然本研究设计不允许进行因果解释，但在参与DM项目期间，CAD和HF患者的HRQOL均显著改善。这一趋势与历史对照相反，在历史对照中，HRQOL并未随时间出现显著改善。
